(A)
For the purposes
of this rule, the following definitions shall apply:

(1)
"Effective date
of termination" means the date set by the state survey agency or the United
States department of health and human services for the termination of
certification.

(2)
"Informal reconsideration" is the process by which
intermediate care facilities may refute in writing, prior to the termination or
non-renewal of medicaid certification, the state survey agency's findings on
which the termination or non-renewal is based. The facility must receive a
written response to the informal reconsideration request which either affirms
or reverses the survey decisions. Informal reconsideration is a process
independent of the formal appeal. The facility may or may not choose to utilize
informal reconsideration.

(B)
When medicaid
certification is either terminated or not renewed, the Ohio office of medical
assistance must terminate the medicaid provider agreement.

(C)
In addition to
or in conjunction with the appeals process, the intermediate care facility may
request informal reconsideration. If informal reconsideration results in an
affirmation of the original survey findings, the appeals process moves forward
to the administrative hearing if one was requested. If informal reconsideration
results in a reversal of the original survey findings, the state survey
agency's termination or non-renewal action, based on those original findings,
is dismissed.

(1)
During the
appeals process provided by the state survey agency for the proposed
termination or non-renewal of medicaid certification, payment under regulations
for covered services provided to eligible residents shall continue through the
earlier of the following:

(a)
The date of issuance of a final order of adjudication
that upholds the state survey agency's termination or non-renewal action;
or

(b)
The one hundred twentieth day after the effective date
of termination of the intermediate care facility's provider
agreement.

(2)
Payment may be provided up to an additional thirty
days following either the cessation of payment on the one hundred twentieth day
post termination or non-renewal; or after the issuance of an adjudication order
that upholds the termination or non-renewal action. Payment will be available
if both of the following conditions are met:

(a)
Payment is for
residents admitted to the intermediate care facility before the effective date
of termination or non-renewal; and

(b)
The intermediate
care facility cooperates with the state, local, and federal entities in the
effort to transfer residents to other facilities or community programs that can
meet the residents' needs.

(E)
When the Ohio
office of medical assistance acts under instructions from the United States
department of health and human services, payment ends on the termination date
specified by that agency.

(F)
When the state survey agency certifies that there is
jeopardy to residents' health and safety by issuing an order under Chapter
5111. of the Revised Code, or when it fails to certify that there is no
jeopardy, payment will end on the effective date of
termination.